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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To examine problems in echocardiographic diagnosis of mitral valve prolapse, multiple crystal cross-sectional echocardiography and single crystal recordings derived from the multiple crystal array were used to study 45 clinically normal children aged 3 to 15 years (Group A), 26 children aged 2 to 10 years with known mitral valve prolapse (Group B), 12 children with a catheterization-proved large left to right shunt at the ventricular level (Group C) and 8 children with catheterization-proved left ventricular outflow tract obstruction (Group D). Children in Groups A and B were not studied hemodynamically. Children in Groups C and D had no evidence of mitral valve prolapse on angiography and were studied echocardiographically to determine the effect of changes in ventricular shape on the patterns of mitral valve motion. In the real time cross-sectional studies, normal patients demonstrated a spectrum of mitral valve motion in which the bodies of the anterior and posterior leaflets became slightly horizontal with systolic ejection. The mitral apparatus assumed a curvilinear funnel shape. Arching of the leaflets into a horizontal configuration was more striking in the presence of either left ventricular dilatation in left to right shunt or involvement of the anterior mitral anulus in subaortic stenosis (two patients) and was associated with false positive M mode tracings suggesting mitral valve prolapse. This latter configuration was easily differentiated from the superior motion of the body of the leaflets in true prolapse. Studies of single crystal M mode recordings derived form the cross-sectional array in known locations from six normal patients revealed M mode patterns of pseudoprolapse in tracings derived from the leaflet body and patterns of normal motion at the free edge. In contrast, superior-posterior prolapse visualized in cross-sectional studies in patients with the click-murmur syndrome was associated with abnormal M mode recordings from all parts of the leaflet, including the free edge, although the abnormalities were most striking in tracings derived from the leaflet body. The M mode echocardiographic findings of mitral valve prolapse in both normal patients and patients with the click-murmur syndrome were dependent upon transducer angulation and the portion of the valve examined. The critical differentiation of the spectrum of normal valve motion from prolapse requires careful evaluation of echoes from the free edge of the leaflet where the posterior and anterior leaflet echoes coapt in early systole.
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PMID:Echocardiographic spectrum of mitral valve motion in children with and without mitral valve prolapse: the nature of false positive diagnosis. 55 83

Among 95 patients with angina pectoris and angiographically documented coronary artery disease (CAD), prolapse of the scallops of the posterior leaflet of the mitral valve (PLMV) was noted in 30 patients. Left ventriculograms in the right anterior oblique (RAO) projection revealed isolated prolapse of the posteromedial commissural scallop (PMCS) in 12 patients and the anterolateral commissural scallop (ALCS) in two patients. Seven patients had prolapse of both PMCS and ALCS, three had prolapse of the PMCS and middle scallop (MS), and six had prolapse of all three scallops of the PLMV. Left ventricular dilatation with increase trabeculations was observed in 19 patients. Contractility determined in a quantitative fashion by segmental motion analysis was markedly impaired in 29 patients. None of the patients had angiographic evidence of mitral insufficiency. Left ventricular dysfunction was documented in 28 patients by either elevated left ventricular end-diastolic pressure (LVEDP), low cardiac index (CI) or decreased ejection fraction (EF). In two patients in whom left ventricular contractility improved after aortocoronary by pass, previously prolapsed scallops could not be identified in the postoperative ventriculogram. Prolapsed PLMV is a frequent angiographic finding in patients with angiographically observed CAD. Impaired contractility of the ventricular myocardium and papillary muscles, left ventricular dilatation, and hypertrophy appear to play a significant role in the pathogenesis of this abnormality through distortion of the directional axis of the papillary muscles, asynergic contraction of the related free wall of the left ventricle, and changes in the normal spatial alignment necessary for mitral valve closure. The syndrome of papillary muscle dysfunction in patients with coronary artery disease represents a wider clinical spectrom than previously described.
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PMID:Mitral valve prolapse and coronary artery disease. Clinical, hemodynamic, and angiographic correlations. 114 6

Over a 5-year period, 1,292 patients had operation on their native mitral valves. Ischemia was the cause of mitral insufficiency in 84 patients (6.5%). Sixty-five patients (77.4%) had mitral valve repair. Mean age was 66 +/- 10 years; 35 patients (53.8%) were women. Mean degree of preoperative insufficiency was 3.2 +/- 0.7; mean preoperative New York Heart Association functional class was 3.3 +/- 0.7. Eleven patients (16.9%) had acute and 54 (83.1%) had chronic mitral insufficiency. Valve prolapse was present in 26 patients (40%). Restrictive leaflet motion secondary to regional or global left ventricular dilatation occurred in 39 patients (60%). All patients had associated myocardial revascularization followed by transatrial valvuloplasty. Multiple techniques were employed to achieve valve competence: leaflet resection (3), chordal shortening (15), papillary muscle reimplantation (10), papillary muscle shortening (3), and annuloplasty (63). There were six (9.2%) hospital deaths (acute, 9.1%; chronic, 9.3% [not significant]; prolapse, 11.5%; restrictive, 7.7% [not significant]). The mean degree of postoperative mitral insufficiency was 0.6 +/- 0.8 in 51 patients. At a mean follow-up of 3.1 +/- 1.6 years, patient survival was 96% for patients with valve prolapse and 48% for those with restrictive leaflet motion (p = 0.02). New York Heart Association functional class was improved in all groups. Ischemic mitral insufficiency is an uncommon cause of mitral valve disease that is amenable to repair in the majority of cases of both acute and chronic onset. The operative mortality is low, and operation is associated with superior survival in patients with valve prolapse.
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PMID:Mitral valve repair for ischemic mitral insufficiency. 161 Feb 45

This study clarified the clinical profile and echocardiographic findings of severe idiopathic tricuspid regurgitation (TR). Among 8,538 consecutive ultrasonic examinations, a total of 63 patients had severe TR, which was depicted by color flow mapping as a regurgitant signal more than 4 cm from the tricuspid valve orifice. Thirteen of the 63 patients had no underlying diseases, and these patients with severe idiopathic TR were the subjects of the present study. All 13 patients were over 66 years of age (mean 77.3 +/- 5.6 years old) and had had episodes of right heart failure which responded effectively to diuretics. All 13 patients had atrial fibrillation. Using two-dimensional echocardiography, thickening (77%), prolapse (69%) and malaligned coaptation (54%) of the tricuspid valves were observed. The tricuspid annular diameters, cross-sectional areas of the right and left atria and the right ventricular end-diastolic dimensions were significantly greater than those of the age-and-gender-matched lone atrial fibrillation group and the normal control group (p less than 0.01). The left ventricular dimension and ejection fraction did not differ from those of the matched lone atrial fibrillation group. Other valvular regurgitations were also detected (AR 77%, MR 100%, PR 69%), but the degrees of regurgitation were minimal. We proposed severe TR with tricuspid annular dilatation, right atrial and right ventricular dilatation observed in the aged as a distinct cardiac disease entity.
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PMID:[Clinical evaluation of severe idiopathic tricuspid regurgitation]. 213 28

The aim of this study involving 700 echocardiographic examinations (echoes) was to evaluate the diagnostic impact of the method for right heart abnormalities. Among 200 two-dimensional echoes of a first series we found 23 abnormalities (11.5%): nine congenital malformations, seven pulmonary hypertensions, four cases of isolated right ventricular dilatation, two tricuspid regurgitations (TR), one right atrial myxoma. In four cases the abnormality was clinically unexpected. In a second series of 500 patients, consecutively subjected to a two-dimensional echo with pulsed-wave and continuous-wave Doppler, we found 119 regurgitations of right heart valves in 98 patients (20%): 35 TR and 24 pulmonary regurgitations (PR) secondary to pulmonary hypertension, 13 TR secondary to tricuspid valve prolapse, 16 TR and 11 PR as a part of polyvalvular disease; 10 TR and 10 PR were isolated observations. The examination technique and the echo signs of the principal abnormalities of the right heart are reviewed. In summary, we emphasize that right heart abnormalities are surprisingly frequent in routine echo investigations; therefore, complete study of all the right heart structures in every echo examination is mandatory.
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PMID:[Echocardiography of the right heart--unknown territory. Contribution of echocardiography and Doppler echocardiography to the study of the right heart]. 265 68

The study was performed in 33 patients with echocardiographic diagnosis of mitral valve prolapse (PVM), without any other associated heart disease. A 19 derivations electrocardiogram (ECG) was performed a direct inscription 4 channel Samborns 150 machine at 25 and 50 mm/sec. The purpose of the study was determine the alterations in ventricular depolarization and repolarization, and to correlate them with valve prolapse, as well as with cavitary and parietal dimensions, as measured by M mode and/or two-dimensional echocardiography. Left ventricular hypertrophy detected by ECG agreed with the ECO test in 77%; the sensitivity was of 86% and specificity of 67.5%. Left ventricular hypertrophy detected by ECG was not related with the type of prolapse. Ventricular repolarization alteration was very frequent (84.8%). Association of this parameter with initial notch of R in a VF becomes important for diagnosis suspicion (p less than 0.01). When the abnormal repolarization affected the anterolateral wall, posterior valve prolapse was frequent; when the posteroinferior region was the affected one, the prolapse occurred more frequently in both valves. An important correlation (p less than 0.01) was found between left ventricular dilatation detected by ECO and the abnormal ventricular repolarization.
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PMID:[Electro-echocardiographic correlation in mitral valve prolapse]. 295 79

A 40-year-old man was admitted to our hospital in May 1982 for evaluation of a heart murmur. A standard 12-lead electrocardiogram (ECG) showed an abnormal Q wave in lead III. Echocardiography revealed prolapse of the anterior mitral valve leaflet (MVP), but neither dilatation nor wall motion abnormalities of the left ventricle (LV) were observed. Thallium-201 scintigraphy revealed an abnormal thallium uptake at the apex and inferior wall. He had no episode of acute myocardial infarction or myocarditis, but complete right bundle branch block suddenly appeared, and he was hospitalized in October 1984. He had no coronary artery lesions, and only mild mitral regurgitation on left ventriculography. The motion of the interventricular septum and apex was reduced on echocardiography and a persistent perfusion defect was observed at the inferior wall and the interventricular septum on T1-201 scintigraphy. In December 1985, he experienced an Adams-Stokes attack due to complete atrioventricular block. Echocardiographically, the left ventricle became enlarged and the wall motion abnormality and a perfusion defect on T1-201 scintigrams were of relatively severe degree. Thus, left ventricular dilatation and wall motion abnormality may progress in some cases of MVP as it did in this one. We consider this case a very interesting one in speculating on the relationship between MVP and DCM.
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PMID:[Regression of mitral valve prolapse to a state masquerading as dilated cardiomyopathy: a case report]. 350 16

Polygraphic (including apexcardiograms and carotid pulse tracings) and M mode echocardiographic examinations were carried out in 34 symptomatic patients with Marfan's syndrome; similar studies were performed in 32 relatives and in 34 young patients with kyphoscoliotic disease. The purpose of these investigations was to determine the association between cardiac and oculoskeletal abnormalities and to identify specific patterns of disease with a poor prognosis. Polygraphic tests showed significant changes in all patients with Marfan's syndrome: 74% showed the apical systolic click and murmur of mitral valve prolapse; 48% had the diastolic murmur of aortic regurgitation; isolated mitral valve prolapse was found in 52%, 26% had isolated aortic regurgitation, and 22% had a combination of the two. Echocardiographic changes were also found in all patients: 79% had aortic root dilatation; 48% fluttering of the anterior mitral leaflet; 79% mitral valve prolapse, mostly pansystolic; 34% both mitral prolapse and aortic root dilatation; and 34% left ventricular dilatation. The severities of the cardiac and oculoskeletal abnormalities were not correlated. The high prevalence of mitral valve prolapse found in these patients, which did not vary with age or sex, was also present in their relatives: mitral prolapse was present in 38% and aortic dilatation, with or without regurgitation, in 14%. Four of the relatives had clearcut Marfan's syndrome, and at least four others a forme fruste. The metacarpal index was abnormal in 41% of the relatives; ocular abnormalities were rare. In kyphoscoliotic patients only an increase in the prevalence of mitral prolapse (18.2% in women, none in men) was found. These findings underline a complex pattern of association between cardiac, ocular, and skeletal abnormalities in patients with Marfan's syndrome and confirm an appreciable inheritability of several of the markers of the disease.
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PMID:Cardiac, skeletal, and ocular abnormalities in patients with Marfan's syndrome and in their relatives. Comparison with the cardiac abnormalities in patients with kyphoscoliosis. 669 72

A 27-year-old man with typical mitral leaflet prolapse syndrome was under medical care for eight years with ventricular arrhythmias resistant to various antiarrhythmic drugs. He was started on digoxin, 0.25 mg daily, because of echocardiographically demonstrated left ventricular dilatation and functional impairment; he died of ventricular fibrillation 15 days later.
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PMID:Fatal ventricular fibrillation after treatment with digoxin in a 27-year-old man with mitral leaflet prolapse syndrome. 729 27

18 adolescents and children who underwent mitral annuloplasty for severe mitral regurgitation were evaluated by echocardiography. In 7 patients studied preoperatively, mitral valve excursion ranged from 25 to 56 mm with E-F slopes from 92 to 160 mm/sec. 5 of the 7 patients showed mitral valve prolapse. The left ventricle was dilated in 6 and the left atrium was dilated in 4 patients. Postoperatively, the mitral valve excursion decreased ( range 15-26 mm; p less than 0.01) as did the E-F slope (range 44-100 mm/sec; 0.10 greater than p greater than 0.05). The prolapse pattern disappeared and the left heart chambers decreased in size. In these 7 patients and in 11 others studied postoperatively only, a common echocardiographic pattern was that of early anterior motion of the posterior mitral valve leaflet, which was not present preoperatively and was, therefore, tentatively ascribed to the technique of annuloplasty repair. No calciferation and no definite mitral steosis has occurred in the follow-up of these patients to date. Persistent left atrial/left ventricular dilatation appeared related to residual mitral regurgitation with or without atrial fibrillation.
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PMID:Echocardiographic patterns after mitral annuloplasty. 736 87


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